One of the challenges facing hospitals today is identifying a patient's primary illness as early as possible, so that appropriate interventions can be deployed immediately. Some illnesses, such as Acute Myocardial Infarction (AMI) and pneumonia, require an immediate standard action or pathway within 24 hours of the diagnosis. Other illnesses are less acute but still require careful adherence to medium and long-term treatment plans over multiple care settings.
The Joint Commission, the hospital accreditation agency approved by the Centers for Medicare and Medicaid Services (CMS), has developed Core Measures that have clearly articulated process measures. These measures are tied to standards that could result in CMS penalties for poor performance. For example, the measures set forth for Acute Myocardial Infarction include:
Set Measure ID #Measure Short NameAMI-1Aspirin at ArrivalAMI-2Aspirin Prescribed at DischargeAMI-3ACEI or ARB for LVSDAMI-4Adult Smoking Cessation Advice/CounselingAMI-5Beta-Blocker Prescribed at DischargeAMI-7Median Time to FibrionolysisAMI-7aFibrinolytic Therapy Received within 30 minutesof Hospital ArrivalAMI-8Median Time to Primary PCIAMI-8aPrimary PCI Received within 90 minutesof Hospital ArrivalAMI-9Inpatient Mortality (retired effective Dec. 31, 2010)AMI-10Statin Prescribed at Discharge
To date, most reporting and monitoring of accountable measure activities are done after the patient has been discharged from the healthcare facility. The delay in identifying and learning about a particular intervention often makes it impossible to rectify any situation. It is also difficult for a hospital administrator to determine how well the hospital is meeting core measures on a daily basis. Clinicians need a real-time or near real-time view of patient progress and care throughout the hospital stay, including clinician notes, that will inform actions (pathways and monitoring) on the part of care management teams and physicians toward meeting these core measures.
Case management teams have difficulty following patients' real-time disease status. The ability to do this with a clear picture of clinician's notes as they change in real-time as new information comes in during a patient's hospital stay would increase the teams' ability to apply focused interventions as early as possible and follow or change those pathways as needed throughout a patient's hospital stay, increasing quality and safety of care, decreasing unplanned readmissions and adverse events, and improving patient outcomes. This disclosure describes software developed to identify and risk stratify patients at highest risk for hospital readmissions and other adverse clinical events, and a dashboard user interface that presents data to the users in a clear and easy-to-understand manner.